General Surgery - Anorectal Flashcards
1
Q
What are the sx of haemorrhoids?
A
- Painless bright red rectal bleeding
- Pruritus
- Rectal fullness or an anal lump, and soiling
- Severe anaemia
2
Q
How are haemmorhoids investigated?
A
- Abdo exam
- PR exam (internal haemmorhoids are not palpable)
- Proctoscopy
- Sigmoidoscopy
3
Q
How are haemmorhoids treated?
A
- Medical: (1st-degree.) ↑Fluid and fibre is key ± topical analgesics & stool softener (bulk forming). Topical steroids for short periods only.
-
Non-operative: (2nd & 3rd degree, or 1st degree if medical therapy failed.)
- Rubber band ligation. Banding produces an ulcer to anchor the mucosa (SE: bleeding, infection; pain)
- Sclerosants: (1st- or 2nd-degree.) 2mL of 5% phenol in oil is injected into the pile above the dentate line, inducing fibrotic reaction. .
-
Surgery:
- Haemmorhoid artery ligaton
- Excisional haemorrhoidectomy
- Stapled haemorrhoidopexy
4
Q
What is Pilonidal sinus disease?
A
- Disease of the inter-gluteal region*, characterised by the formation of a sinus in the cleft of the buttocks
- Commonly affects males aged 16-30 years
- It is starting from a hair follicle in the intergluteal cleft becoming infected or inflamed
5
Q
How does pilonidal sinus disease present?
A
- Intermittent red, painful, and swollen mass in the sacrococcygeal region
- Commonly discharge from the sinus
- Pilonidal sinus opens up onto the skin, but does not communicate with the anal canal
6
Q
How do you manage pilonoidal sinuses?
A
- Conservative: shaving the affected region and plucking the sinus free of any hair. Abx
-
Surgical
- Incision and drainage; chronic: removal of the pilonidal sinus tract.
- Excising the tract and laying open the wound
7
Q
What is a perianal fistula?
A
Abnormal connection between the anal canal and the perianal skin
8
Q
What are some of the causes of peri anal fistula?
A
- IBD – Crohn’s/ UC
- Systemic diseases – Tuberculosis, diabetes, HIV
- Trauma hx - to the anal region
- Previous radiation therapy to the anal region
9
Q
How would we predict the trajectory of fistula?
A
The Goodsall Rule
- External opening posterior to the transverse anal line – fistula tract will follow a curved course to the posterior midline
- External opening anterior to the transverse anal line – fistula tract will follow a straight radial course to the dentate line
10
Q
What classification is used to divide anal fistula into four distinct types:
A
Park’s classification system
- Inter-sphincteric fistula (most common)
- Trans-sphincteric fistula
- Supra-sphincteric fistula (least common)
- Extra-sphincteric fistula
11
Q
How are fistula managed?
A
Surgical:
- A fistulotomy: laying the tract open by cutting through skin and subcutaneous tissue, allowing it to heal by secondary intention
- The placement of a seton: (suitable for high tract disease) though the fistula attempts to bring together and close the tract, passing out at opening of the perianal skin adjacent to the external opening
12
Q
What causes anorectal abscesses?
A
- Caused by plugging of the anal ducts, the ducts that drain the anal glands in the anal wall, helping to ease the passage of faecal matter through mucus secretion.
- Blockage -> fluid stasis -> infection
- Common causative organisms include E. coli, Bacteriodes spp., and Enterococcus spp..
13
Q
How are anorectal abscesses managed?
A
- Conservative: analgesia + abx
- Surgical: surgical incision and drainage. These can then be left to heal via secondary intention
- Proctoscopy post drainage to check for perianal fistula
14
Q
What is an anal fissure?
A
- Tear in the mucosal lining of the anal canal, most commonly due to trauma from defecation of hard stool.
- It can be classified according to its duration:
- Acute – present for <6 weeks
- Chronic – present for >6 weeks
15
Q
What are the symptoms of anal fissure?
A
- Intense pain post-defecation, which can last several hours.
- Pain can be far out of proportion to the size of the fissure
- Other sx: may include bleeding (commonly bright red blood on wiping) or itching, both typically post-defecation.
